Positive Symptoms of Schizophrenia: A Patient’s View

She was referred to me by a consultant psychiatrist, diagnosed as schizophrenia, and taking some medication for the past few years. She is compliant with the medication, even though the medication makes her struggle to wake up every morning. She has a job. She completed a degree few years ago, and has been able to hold her job most of the years despite her illness.

I remember during our first session we talked quite a lot about the symptoms of schizophrenia. She used to have paranoid delusion (suspecting that a fellow friend from the uni is following her and trying to do her harm etc), but now has only auditory hallucination (hearing voices of the ex-coursemate).

The consultant psychiatrist and I always thought that she had good insights into her symptoms and illness. Until it was the 4th session, she disclosed that she never thought she had any illness. Why was she taking the medicine? Because it helps her emotionally, feel calmer. I suddenly realised that it was true in her case, because her antipsychotic drugs have never reduced/ceased her voices.

Sometimes it seems that the voice is like a friend to her. We have discussed that if there is no way to remove the voices right now, how she can live with the voices, and she seems ok with it (sometimes). But after more discussion, I realised that her problems with this voice is because the voice broadcasts her thoughts. She always thinks that others can read her mind, and it’s due to this voice. She can live with this voice if there is no way to get rid of it, but she can’t live with this voice telling everyone else her thoughts…… (she gave quite some good examples of others knowing her thoughts and responding accordingly, and she thinks all these were too much a coincidence).

She believes that the voice in the mind is machinery operated, and this machine is controlled by the ex-coursemate. Once during a breakdown, she even went to confront the person, and the person denied having done that to her. Now when she’s relatively well, she thinks there is no point to confront the person, because the ex-coursemate would surely deny (and she wouldn’t believe that).

From the Psychology’s perspective, both delusion and hallucination are common positive symptoms of schizophrenia. They also tend to happen together.

From the client’s perspective, it’s more complicated than that. Because she doesn’t think they are two separate symptoms of an illness. They are one thing, the voice (hallucination) broadcast her thought (mind being read – delusion).

I surely didn’t attempt to argue with or convince her that it was just her illness. I’m not being irresponsible or denying my job and role as her therapist (I can and will still help her in many other ways), but consider this carefully, is there any point at all to do that in her case? (especially that she’s almost fully functional and is taking her medicine regularly and attending therapy session monthly). After all, who knows she might be right and I might be wrong? Who says everything I learnt in my degrees must be right when the so-call anti-psychotics are not ceasing/reducing her positive symptoms? Who is the expert in one’s illness?